UnitedHealthcare (UHC) is putting providers on notice: Come Jan. 1, 2019, the industry giant will use the SEP-3 definition to determine if a diagnosis of sepsis is clinically validated, advising that the Sequential (sepsis-related) Organ Failure Assessment (SOFA) score is to be used to determine if sepsis is present.
If reviewers find no SOFA score in the medical record, that could spell trouble – audit trouble. Reporting on this topic during this edition of Monitor Mondays is Edward Hu, MD, executive director of Inpatient Physician Advisor Services for the University of North Carolina Health Care System and president of the American College of Physician Advisors.
The broadcast rundown also will include:
- The RAC Report: Healthcare attorney Knicole Emanuel reports on a flurry of new cases in which judges are ordering the government to refrain from recouping alleged overpayments until a hearing has been held. Immediate recoupments, currently allowable by law, fundamentally violate our country’s concept of due process.
- Medicare Advantage Report: A recent investigation by the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) found that Medicare Advantage plans overturned 75 percent of their denials. Timothy Powell, Monitor Monday national correspondent, reports on this developing story.
- Rural Health Report: There has been a spike in the closure of rural hospitals, according to the Government Accountability Office (GAO). In a recent report, the GAO says that a total of 64 rural hospitals closed between 2013 and 2017. In the face of that bad news, Leslie Marsh, the chief executive officer for Lexington Regional Health Center in Lexington, Neb., reports on the positive economic impact her facility is having on the community.
- Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron reports on another example of a potentially troublesome issue that could pose a risk to your facility.
- Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment.
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